Alternative antibacterial therapy of Methicillin-resistant Staphylococcus aureusin patients with diabetic foot and sepsis

Igor Leonidovich Savon; Sergiy Dmytrovich Shapoval; Olga Olegivna Maksymova; Michael Mykhailovich Sofilkanych; Michael Ivanovich Sheremet; Oleksandr Viktorovich Shidlovskyi; Oleksandr Volodimirovich Lazaruk

Igor Leonidovich Savon Department of outpatient purulent septic surgery and ultrasonic diagnostics, State Institution «Zaporizhia Medical Academy of Postgraduate Education of Ukrainian Ministry of Health», Zaporizhia, Ukraine
Sergiy Dmytrovich Shapoval Department of outpatient purulent septic surgery and ultrasonic diagnostics, State Institution «Zaporizhia Medical Academy of Postgraduate Education of Ukrainian Ministry of Health», Zaporizhia, Ukraine
Olga Olegivna Maksymova Department of outpatient purulent septic surgery and ultrasonic diagnostics, State Institution «Zaporizhia Medical Academy of Postgraduate Education of Ukrainian Ministry of Health», Zaporizhia, Ukraine
Michael Mykhailovich Sofilkanych Department of outpatient purulent septic surgery and ultrasonic diagnostics, State Institution «Zaporizhia Medical Academy of Postgraduate Education of Ukrainian Ministry of Health», Zaporizhia, Ukraine
Michael Ivanovich Sheremet Surgery Department №1, Bukovinian State Medical University, Ukraine
Oleksandr Viktorovich Shidlovskyi Surgery Department, I. Horbachevsky State Medical University, Ukraine
Oleksandr Volodimirovich Lazaruk Department of Pathology (Pathology and Forensic Medicine), Bukovinian State Medical University, Ukraine

Keywords: sepsis, diabetic foot, Methicillin-resistant Staphylococcus aureus, antibacterial therapy.

Abstract

A total of 210 patients with diabetic foot and sepsis who were treated in the purulent-septic center of Zaporizhzhya, Ukraine, were examined for the period of 2007–2020. All patients had type II diabetes mellitus, with a duration of 12.6 ± 2.7 years and an age of 56.8 ± 2.5 years. The diagnosis of sepsis is established according to the criteria of Sepsis-3 (2016). The complex of therapeutic measures included the mandatory use of antibacterial drugs, which was preceded by a microbiological study of biological material (blood and wound discharge). Gram-positive flora was detected in 118 (56.2%) patients and prevailed over gram-negative 81 (38.6%), anaerobes were detected in six (2, 8%) patients, and fungal flora in five (2.4%). Among patients diagnosed with Staphylococcus aureus 52 (100%), Methicillin-resistant Staphylococcus aureus (MRSA) prevailed with 38 (73.0%) (p < 0.05). We have identified a pattern that allowed us to categorize patients with MRSA into four groups according to similar sensitivity to antibacterial drugs, which received the conventional designations MRSA type 1; MRSA type 2; MRSA type 3; MRSA type 4. Moreover, MRSA type 4–3 (7, 9%) of the patient is pan-resistant. The most universal drugs in the presence of MRSA in patients with sepsis caused by complicated DFS are daptomycin, linezolid, teicoplanin, vancomycin, and tigecycline. In patients with MRSA type 1 and MRSA type 2, except standard anti - MRSA antibiotics, aminoglycosides, fluoroquinolones and macrolides can be effectively used as first-line drugs.